Generic Tiazac

DILTIAZEM HCI
Tablets: 30, 60, 90 and 120 mg (Rx) Various, Cardizem (Marion Merrell Dow)
Capsules, sustained-release: 60, 90, 120, Various, Cardizem SR (Marion Merrell Dow)
180, 240, 300 and 360 mg (Rx) Cardizem CD (Marion Merrell Dow),
Dilacor XR (Rhone-Poulenc Rorer), Tiazac (Forest)
Injections: 25 mg (5 mg/50 mL),
50 mg (5 mg/mL) (Rx) Cardizem (Marion Merrell Dow)

Oral-
Tablets: Start with 30 mg 4 times/day before meals and at bedtime; gradually increase dosage to 180 to 360 mg (given in divided doses 3 or 4 times/day) at 1-to 2-day intervals until optimum response is obtained.
Sustained release:
Cardizem SR -Start with 60 to 120 mg twice daily. Adjust dosage when maximum antihypertensive effect is achieved (usually by 14 days chronic therapy). Optimum dosage range is 240 to 360 mg/day, but some patients may respond to lower doses.
Cardizem CD -
Hypertension: 180 to 240 mg once daily; some patients may respond to lower doses. Maximum antihypertensive effect is usually achieved by 14 days chronic therapy; therefore, adjust dosage accordingly. Usual range is 240 to 360 mg once daily; experience with doses > 360 mg is limited.
Angina: Start with 120 or 180 mg once daily. Some patients may respond to higher doses of up to 480 mg once daily. When necessary, titration may be carried out over a 7- to 14-day period.
Cardizem CD may be opened and administered, but do not crush.
Dilacor XR -
Hypertension: 180 to 240 mg once daily; adjust dose as needed. Individual patients, particularly those > 60 years of age, may respond to a lower dose of 120 mg. Usual range is 180 to 480 mg once daily. Although current clinical experience with the 540 mg dose is limited, the dose may be increased to 540 mg with little or no increased risk of adverse reactions. Do not exceed 540 mg once daily. Angina: Adjust dosage to each patient's needs, starting with a dose of 120 mg once daily, which may be titrated to doses of up to 480 mg once daily, when necessary, titration may be carried out over a 7- to 14-day period.
Hypertensive or anginal patients treated with other formulations of diltiazem can safely be switched to Dilacor XR at the nearest equivalent total daily dose. However, subsequent titration to higher or lower doses may be necessary and should be initiated as clinically indicated.
Administration in the morning on an empty stomach is recommended.
Parenteral -
Direct IV single injections (bolus): The initial dose is 0.25 mg/kg as a bolus administered over 2 minutes (20 mg is a reasonable dose for the average patient). If response is inadequate, a second dose may be administered after 15 minutes. The second bolus dose should be 0.35 mg/kg administered over 2 minutes (25 mg is a reasonable dose for the average patient). Individualize subsequent IV bolus doses. Dose patients with low body weights on a mg/kg basis. Some patients may respond to an initial dose of 0.15 mg/kg, although duration of action may be shorter.
Continuous IV infusion: For continued reduction of the heart rate (up to 24 hours) in patients with atrial fibrillation or atrial flutter, an IV infusion may be administered. Immediately following bolus administration of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) and reduction of heart rate, begin an IV infusion. The recommended initial infusion rate is 10 mg/hr. Some patients may maintain response to an initial rate of 5 mg/hr. The infusion rate may be increased in 5 mg/hr increments up to 15 mg/hr as needed, if further reduction in heart rate is required. The infusion may be maintained for up to 24 hours. Therefore, infusion duration > 24 hours and infusion rates > 15 mg/hr arc not recommended.
Concomitant therapy: Concomitant therapy with p-blockers or digitalis is usually well tolerated, but the effects of co-administration cannot be predicted, especially in patients with left ventricular dysfunction or cardiac conduction abnormalities. Use caution in titrating dosages for impaired renal or hepatic function patients, since dosage requirements are not available.
CARDIO & BLOOD – CHOLESTEROL

SECONDARY PREVENTION OF CHD (CORONARY HEART DISEASE)
Approximately 60% of overweight (body mass index [BMI] > 95th percentile) youth, including children aged 5 to 10 years, have at least one risk factor for future CVD, including blood pressure elevation, abnormal lipids, and insulin elevation, and more than 25% have two or more of these risk factors. Thus, all overweight children/ adolescents must have secondary preventive reductions in CVD risk. The parents of these children should be counseled to reduce time in sedentary activities such as TV viewing, and parents should engage children in more play.
The American Heart Association has just released the recommendation that screening for heart disease be started at the age of 20 years. They advise determining the need for secondary prevention by:
- Updating family history of CHD regularly
- Assessing smoking status, diet, alcohol intake, and physical activity at every routine evaluation
- Recording blood pressure, BMI, waist circumference, and pulse (to screen for atrial fibrillation) at each visit (at least every 2 years)
- Measuring fasting serum lipoprotein profile and fasting blood glucose at least every 5 years; if risk factors are present, every 2 years.
The AHA has issued these recommendations for patients older than 40:
- These patients should know their absolute risk of developing CHD.
- Adults, especially those with two or more risk factors, should have their 10-year risk of CHD assessed with a multiple risk factor score every 5 years (or more often if risk factors change)
- Risk factors used in the global risk assessment should include: age, gender, smoking status, physical activity level, systolic (sometimes diastolic) blood pressure, total (and sometimes LDL) cholesterol, HDL cholesterol, and, in some risk scores, diabetes. (Note: we include physical inactivity here because the AHA included it elsewhere in their recommendations.)
- A patient with established diabetes, or a 10-year risk for diabetes over 20%, can be considered "CHD equivalent," which is to say that he or she has a risk profile similar to a patient with established CHD.
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CARDIO & BLOOD

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